Nemluvio — Medical Mutual

Prurigo nodularis

Initial criteria

Patient is age ≥ 18 years; AND
Patient has ≥ 20 identifiable nodular lesions in total on both arms, and/or both legs, and/or trunk; AND
Patient has experienced pruritus for ≥ 6 weeks; AND
Patient meets ONE of the following: (a) The prurigo nodularis is NOT medication-induced or secondary to a non-dermatologic condition such as neuropathy or psychiatric disease; OR (b) The patient has a secondary cause of prurigo nodularis that has been identified and adequately managed, according to the prescriber; AND
Patient meets two of the following three conditions: (a) Patient did not respond adequately to (or is not a candidate for) a 3-month minimum trial of topical agents [e.g., corticosteroids, calcineurin inhibitors (tacrolimus or pimecrolimus), crisaborole]; OR (b) Patient did not respond adequately to (or is not a candidate for) a 3-month minimum trial of at least one systemic agent (e.g., cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, oral corticosteroids); OR (c) Patient did not respond adequately to (or is not a candidate for) a 3-month minimum trial of phototherapy (e.g., PUVA, UVB); AND
Nemluvio is prescribed by or in consultation with an allergist, immunologist, or dermatologist.

Patient has already received at least 4 months of therapy with Nemluvio; AND
Patient has experienced a beneficial clinical response, defined by ONE of the following: (a) Reduced nodular lesion count; OR (b) Decreased pruritus; OR (c) Reduced nodular lesion size.

initial: 4 months; reauth: 1 year